About Adoptee Rage

Statistics Identify large populations of Adoptees in prisons, mental hospitals and committed suicide.
Fifty years of scientific studies on child adoption resulting in psychological harm to the child and
poor outcomes for a child's future.
Medical and psychological attempts to heal the broken bonds of adoption, promote reunions of biological parents and adult children. The other half of attempting to repair a severed Identity is counselling therapy to rebuild the self.

Sunday, November 23, 2014

Adopted Child's prolonged Exposure to Prolonged Childhood Adversity


Adopted Children's Prolonged Exposure to Prolonged Childhood Adversity 


Exposure to profound adversity in childhood, while the brain and mind are rapidly developing, can cause severe post-traumatic stress. It also can cause alterations in development that may change the entire course of a child’s life and health. This has been amply illustrated by the accumulating findings of a profound negative impact of adverse childhood experiences medical on health as well as psychosocial development and quality of life (see ACE Study).

Such “developmental traumas” appear to shift the brain away from activation based on creatively exploring the world—what I have called the “learning brain” in the 2009 book with Christine Courtois, Treatment of Complex Traumatic Stress Disorder. Childhood adversity can lead, instead, to a brain organized around chronic hypervigilance (the "survival brain").

Survival-oriented changes in the brain are necessary for the children who face threats to their fundamental protective relationships and their very survival. When the brain stays in survival mode beyond its funcational necessity, three key self-regulation systems in the brain are impacted: the reward/ motivation systems (centering on midbrain areas responsive to the neurotransmitter dopamine), the distress tolerance systems (centering on limbic brain areas responsive to the neurotransmitters serotonin and adrenaline), and “executive” systems for emotion and information processing (centered on the medial and dorsolateral prefrontal cortices).
The result is that the child grows up with a brain that has been hijacked by its own alarm system, as we described in Hijacked by Your Brain. This can lead to serious problems including alcohol and substance use, health risks such as smoking and obesity, mental health outcomes such as depression and suicidality, and social risks such as violent relationships, teen pregnancy, and delinquency (seewww.cdc.gov/ace/).
These problems often lead to a laundry list of multiple distinct “comorbid” disorder diagnoses, but when they stem from being struck in survival mode after childhood adversity, they may be better understood and treated as a single—albeit complex—“developmental trauma disorder” (DTD). DTD is not recognized as a psychiatric diagnosis in the DSM-5, but may warrant inclusion in the future if research demonstrates its clinical utility as a syndrome.
A step toward that goal was taken in a study, published this month by the DTD Field Trial Study Team that I lead with Drs. Bessel van der Kolk, Joseph Spinazzola, Damion Grasso, Carolyn Greene, and Joan Levine, M.P.H., in the Journal of Clinical Psychiatry. We conducted an international internet survey of several hundred child-serving clinicians, including psychologists as well other mental health, social, work, medical and nursing clinicians. They reported their views on childhood developmental trauma and the symptoms that have been shown in study after study to follow severe childhood adversity.

They rated the clinical significance of those potential DTD symptoms, including behaviorally specific items describing children’s emotion dysregulation, dissociation, somatoform problems, self-harm, disorganized attachment, risky and impulsive behavior, and aggression. They also rated the clinical significance of symptoms of PTSD and other existing psychiatric disorders, in order to help us gauge whether clinicians see the DTD symptoms as clinically viable compared to the existing DSM-IV and DSM-5 disorder symptoms.
Overwhelmingly, the clinicians who responded consistently said that developmental adversity and associated alterations in self-regulation were crucial to understanding and treating their traumatized child clients. They viewed the DTD symptoms as related to, but not fully accounted for or assessed adequately with existing psychiatric diagnoses. They also viewed the DTD symptoms as: distinct from, but comparable, in clinical utility to symptoms of PTSD and other psychiatric disorders. And of particular importance, they viewed existing evidence-based psychotherapeutic treatments as at best partially effective—and often ineffective—in treating DTD symptoms.
While the symptoms of other psychiatric disorders were viewed as clinically significant—including those of PTSD and a variety of internalizing and externalizing disorders of childhood and adolescence—clinicians from a variety of disciplines said essentially that our toolkit needs to be expanded in order to understand and effectively address the adverse impact of the threats to physical and psychological survival posed by severe childhood adversity.
Interestingly, as I’ve discussed in another Psychology Today blog recently, the revised PTSD diagnosis in the DSM-5 has adopted a number of new or modified symptoms that are similar or even identical to the proposed DTD symptoms. Whether DTD still is needed in order to fill a crucial gap in the clinician’s toolkit and in scientific research is a next key question. As we continue to work toward providing effective treatment to developmentally traumatized children—and adults who suffered developmental trauma in their childhoods—without burdening them with any more psychiatric diagnoses than is absolutely necessary, DTD may have a role to play. DTD will not replace any existing diagnosis, including PTSD, but it could serve as the basis for a more consolidated and less stigmatizing diagnostic summary and approach to treatment for children and adults whose lives, and brains, have been hijacked by complex trauma.